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Lymphocytic choriomeningitis (LCM) virus, an arenavirus, was one of the earliest viruses to be reported as a cause of aseptic meningitis. It accounted for a significant number of cases in early studies but is now rarely reported. It is transmitted to humans by contact with rodents or their excreta. LCM virus most commonly affects young adults in the late fall and winter. Symptoms include malaise, severe headache, photophobia, lightheadedness, and myalgias. A small subset of patients may experience orchitis, arthritis, myopericarditis, or alopecia as late manifestations, hypothesized to be immunologic complications.
Cerebrospinal fluid findings are not different from other causes of aseptic meningitis, although hypoglycorrhachia is seen in up to one fourth of cases. The diagnosis is most often made serologically. Most cases resolve spontaneously, although convalescence may be prolonged. Fatal cases and those with severe neurologic sequelae are rare. Treatment is primarily supportive.
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Worry is a protracted or recurrent act of the mind, which always fails to result in a constructive solution of the question and usually ends in confusion, fatigue, and emotional instability. You can concern yourself about an important problem, if this means merely a careful consideration in an orderly manner, leading eventually to an acceptable conclusion. Even when the conclusion happens to be contrary to your wishes, it may be accepted as a conclusion and thus worry can be avoided. Such an effort is constructive, whereas worry is always destructive.
The ordinary dictionaries describe worry as feeling or expressing a great deal of care and anxiety, manifesting unrest or pain, fretting, chafing, being anxious or fearful. Since all of these reactions are undesirable from the point of view of their effects on the body, worry is a most undesirable characteristic.
Many people insist that they never worry. These are the people who have learned to reason themselves out of anxiety over situations in which they find themselves. The process is known as “rationalizing.” Other people developmental tranquillity or peace of mind by accepting a belief which eliminates from consideration anything displeasing to them. Such a process is not rationalizing, but may achieve the same effect if the person can shut out completely any problem that disturbs him.
Most people find peace of mind necessary if they are to accomplish their responsibilities in the business world or in the home. Without such peace of mind there is a constant feeling of insecurity, a constant fear of a threat to life itself or to the life situation of the person concerned. As a result, energy is squandered and the reserve of the nervous system is exhausted, so that the person becomes tired, worn, distressed and may have what is commonly called a nervous breakdown.
When worry appears to this extent, the effects manifest themselves on different portions of the body. If the worry is related to the heart the person feels palpitations, extra and light beats of the heart, and similar manifestations; such a person may focus attention unduly on the pulse or the blood pressure or some other factor related to the circulation. If the nervous condition brings the focus of attention on the stomach and bowels there may be constipation, diarrhea, or other manifestations even more serious.
Many a person endeavors to escape from worry by fleeing into an addiction to drink, to drugs, to sedatives, to gambling, or to other practices that are known to be against his best interests. The escape is only temporary, and the trouble returns just as soon as the liquor or the drugs have worn off. A restful night’s sleep, a vacation, indulgence in outdoor sports, or even the theater or the movies may be utilized to better advantage as means of escape from the reality of worry.
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On the whole, recovering addicts are a healthy bunch once they have been a year or more away from drugs. Nevertheless, if they do become ill, many of them worry about what drugs and medicines they should take.
The guiding rule is: only take drugs which are legitimately prescribed for a real illness by a doctor who knows about addiction. All addicts and alcoholics should explain their history of addiction to any doctor or dentist who is treating them. They should also tell any hospital authorities that need to know. For instance, addicts and alcoholics usually need larger doses of anaesthesia.
Be specific about what drugs you were using, and how long you have been clean and sober. Tell the doctor that you need to avoid any mood-altering drugs because as a recovering addict or alcoholic you are likely to become addicted to them.
This means keeping away from all tranquillisers and sleeping pills, which doctors sometimes prescribe quite freely. Given to ordinary people in small doses, these drugs are harmless. But for addicts or alcoholics they are a serious problem. It is better to remain temporarily sleepless and anxious than to take the benzodiazepine drugs.
You should also stay away from cough medicines, kaolin-morphine mixtures, and any patent medicines which contain codeine, paracetamol, alcohol and morphine. Always check exactly what patent medicines contain before buying them.
If taking any liquid medicine, check with the chemist whether it has an alcohol base. Many liquid medicines do. Stick to aspirins (soluble and otherwise) as painkillers. If you are prescribed painkillers in hospital after an operation, don’t take them home with you afterwards. If there is a legitimate medical condition for which you need painkillers, take the minimum. Collect small prescriptions regularly rather than one large prescription for several weeks.
Unfortunately, not all doctors understand addiction. Quite unknowingly, some will prescribe unsuitable medicines even though you have told them that you are a recovering addict or alcoholic.
Alison discovered when she asked her family doctor about migraine that he didn’t understand about addiction. ‘He gave me DF 118, which I later discovered was a synthetic narcotic. I didn’t know what it was. I took half the dose and felt really spaced out. So I threw away the pills and now 1 only use aspirin, and not too much of that.’
If you have this kind of trouble with a doctor, it may be worth changing to a different practice. Most family doctors are only too delighted when an addict or an alcoholic becomes clean and sober. But there remain some who simply don’t understand chemical dependence, and who thus may be irritated with addicts trying to avoid mood-altering drugs. It is probably best to change doctors rather than stay with a doctor who does not understand your illness. Local NA or AA members will know of sympathetic practitioners.
Make use of drug-free alternatives to traditional medicine, if you think they will help. Avoid therapies that are run by religious cults, pushed by high-pressure sales techniques, or which charge unreasonably high fees. Faddish or extreme diets should be avoided too.
Just like ordinary people, recovering addicts and alcoholics sometimes develop other emotional disorders which require help. Get help from a counsellor or therapist who understands chemical dependence and alcoholism, so that your underlying difficulties can be tackled. It is always better to try to talk your problems away first, rather than medicate them away. You will find other NA and AA members know of therapists they have found useful. Ask around the meetings.

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One of the ways to help you get through the first few days is to do something about that mind of yours. You may truly want to stop using drugs or drinking, and yet your mind seems to be full of ‘funny’ thoughts about using again or about taking a drink.
Remember, addiction is a psychological illness. Your mind got addicted to drugs and alcohol too. It may be trying to sabotage your efforts in order to get back to the drugs or the drink that it craves.
‘It was as if my mind was divided into two. Part of it, the real me, wanted to stop and get better. But the other part wanted to go on drinking. I would have thoughts that perhaps I wasn’t really an alcoholic. Or thoughts about drinking again would come into my mind. It’s not easy to explain. But I had to make sure somehow that I was on the side of the sane part of my mind – the part that wanted to get well. I had to try and replace the drinking and using thoughts with thoughts that helped me stay sober,’ is how one recovering alcoholic puts it.
One way to think yourself well is to remember all the bad things about using and drinking. When the thoughts about the good times come into your mind, replace them with the thoughts about the bad times.
‘Don’t let anybody tell you that using drugs isn’t fun in the beginning: it is,’ says one addict. ‘But don’t let anybody tell you it’s fun to steal from your mother’s purse, to see your sister crying, to become a homosexual prostitute to get money for drugs.’
The bad things that happened to you can help you get well – if you keep them in your mind during these first few days. One housewife who was addicted to tranquillisers wrote out a list of these things and put it on her fridge door to remind herself why she was giving up the pills.
Use the bad memories. If there’s something particularly degrading that drugs or drink led you to, cherish that awful memory. Every time you get a tempting thought about going back to
drug-taking or drinking, replace it with that bad memory. It will remind you why you should not take drugs or drink.

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Drowsiness The baby is less alert than usual. He makes less eye contact, and is generally less aware of sounds and movement and the immediate environment. The more drowsy the baby, the greater the chance of serious illness being present.

Decreased activity The baby is less active, and moves arms and legs less. He may just tend to lie around, or want to be cuddled by a parent rather than be involved in activities that are normally of interest.

Breathing difficulty This is an important sign of a potentially serious illness, and may take several forms. The baby may be breathing very quickly, or grunting with each breath. He may be coughing non-stop, and with each breath you may notice the muscles between the ribs being sucked in, or else he may be blue around the mouth. Sometimes it is difficult for parents to assess the baby’s breathing, and you should not hesitate to seek immediate medical advice if you are unsure. Poor circulation The baby may look paler than usual, and this can last for up to several hours. In addition, you may notice that his hands and feet may be cold or even blue.

Poor feeding The baby drinks much less than usual. Breastfed babies suck less strongly and for shorter periods of time. Bottle-fed babies take less than half the normal amount of milk that they normally drink in 24 hours. The baby may not be very interested in feeding in general.

Poor urine output The baby has fewer than four wet nappies in 24 hours.

The more of these signs the baby or young child has, the more chance there is that he has a potentially serious illness. You should see the doctor if any one of these signs is present in your child. If the child shows more than one of these signs, you should seek urgent medical attention.

A doctor should also see the baby as a matter of urgency if any of the following

occur:

• the baby vomits green fluid;

• the baby has a convulsion (fit);

• the baby has a very high temperature (fever). (Note that a high fever is potentially much more serious in a baby of less than 6 months than it is in an older child. Fever in a baby always needs medical attention as it is more likely to indicate a significant and potentially serious infection.);

• the baby stops breathing for more than 15 seconds (apnoeic episode);

• the baby has a lump in the groin area (hernia).

Remember that in babies and young children illness can progress more quickly. If in doubt, seek medical advice.

Sometimes parents may put off seeking advice for a variety of reasons. They may not want to worry the doctor with what may turn out to be a trivial illness, especially at night or if they think that he or she is very busy. They may be anxious that their fears are groundless and that they will appear foolish if the baby turns out to have a minor illness. In addition to diagnosing and treating illness, one of the most important things that a doctor should do is to reassure parents that their child is in fact well. This can alleviate a lot of unnecessary anxiety.

If you are concerned, for whatever reason, you should seek medical advice. Usually this will mean taking the child to your general practitioner. Most doctors repeated difficulty getting a rapid appointment for your baby to be seen by a doctor, or if you are made to feel guilty for ‘wasting the doctor’s time’, then it may be time to find a different doctor.

If you are worried about your baby or young child for any reason, do not hesitate to seek medical advice.

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TYMPANOMETRY

This test is used to detect the presence of abnormalities of the middle ear, such as whether fluid is present, or whether there is ‘glue ear’. A sophisticated probe attached to an earplug is placed in the child’s ear. This may be slightly uncomfortable but does not hurt. It will help if you sit your child on your knee during the procedure, and continually reassure him. The probe varies the pressure in the ear and results in a graphic printout which represents the functioning of the middle ear. The doctor uses this to determine whether there are abnormalities which need to be treated. Tympanometry is often performed in conjunction with a hearing test.

ULTRASOUND SCANNING

Ultrasound is a technique which uses high frequency sound waves to produce an image on a television screen of internal organs. The sound waves are bounced off individual organs, and converted into pictures. Different organs have characteristic appearances on ultrasounds, so structural abnormalities can be discovered in this way. Many organs can be visualised well using the ultrasound technique but not all can.

The procedure is quite painless. The person to be examined is asked to lie on a bed and an instrument which looks like a microphone is covered in jelly and then rubbed over the abdomen. The procedure does not involve the use of radiation.

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